Long-term outcome of local excision after complete pathological response to neoadjuvant chemoradiation therapy for rectal cancer

Abstract

Background: Neoadjuvant chemoradiotion therapy (CRT) for advanced rectal cancer has improved local disease. Complete rectal wall tumor regression may be associated with the absence of viable cancer cells in the mesorectum, and thus local excision (LE) of such lesions as an alternative to radical surgery has recently gained interest. We report the long-term outcome of LE in patients with a mural pathological complete response (ypT0) after CRT.

Methods: A retrospective review of patients with rectal cancer treated by CRT and followed by LE with pathological complete response in the specimen between 1998 and 2009 was performed.

Results: A total of 174 patients had neoadjuvant CRT, and 68 (39 %) showed complete clinical response (cCR). Thirty-one of the cCR patients underwent LE; 23 of them resulted in ypT0 and 8 had residual disease. The ypT0 group included 12 men and 11 women with a median age of 66. The pretreatment stage was T3N1 in 4 (17 %) patients, T3N0 in 11 (48 %), T2N1 in 3 (13 %), and T2N0 in 5 (22 %). The median tumor distance from the anal verge was 6 cm. Sixteen patients (70 %) underwent transanal excision, and 7 (30 %) were treated by transanal-endoscopic microsurgery. Three patients died: one of pneumonia, one of melanoma of the rectum, and one of lung carcinoma. No local or distant recurrences were detected in the remaining 20 patients. The median follow-up was 87 months.

Conclusions: Although radical rectal resection is the treatment of choice, LE of complete rectal tumor regression could be a safe alternative with an acceptable result in selected patients.